AccountId: 011433970860
ContactId: 84b01f31-bfad-4bd2-a176-08424f979770
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 507309 ms
Total Talk Time (AGENT): 198073 ms
Total Talk Time (CUSTOMER): 156843 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/27/84b01f31-bfad-4bd2-a176-08424f979770_20250127T19:16_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, hi [PII]. Uh, my name is [PII]. I can spell my name is [PII], and I'm calling on behalf of Sentle Medical Group to verify the claim status. Can you please help me out with that?
[AGENT][NEUTRAL] OK, now you're needing to check a claim status, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number, please?
[CUSTOMER][NEUTRAL] Uh, the callback number is [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy, I will first off, how many claims Mr. did you have to check status?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Uh, I only have one claim. I mean the one patient with the two data of service.
[AGENT][NEUTRAL] How many dates of service?
[CUSTOMER][NEUTRAL] It's 2 data service.
[AGENT][POSITIVE] OK, yes ma'am, I can help you. And now first off, you will use my name that I gave you along with today's date as your call reference number.
[AGENT][NEUTRAL] And if the claim, yes ma'am, [PII].
[CUSTOMER][NEUTRAL] Uh, can you spell your name please?
[AGENT][NEUTRAL] And if we do have the claims on file and you need a copy of the explanation of benefits, we have a portal in which you can print those from and our portal website measuring is secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is your patience? Oh, I'm so sorry, his name's secured. [PII].
[CUSTOMER][NEUTRAL] AM
[CUSTOMER][NEUTRAL] Yeah, go ahead please.
[AGENT][NEUTRAL] OK, and what is your patient's policy number please?
[CUSTOMER][NEUTRAL] Yeah, the patient policy number is
[CUSTOMER][NEUTRAL] 0230.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 2396.
[AGENT][POSITIVE] Thank you. One moment please.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, and what is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah. The uh patient name.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh, [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And you said there are 2 dates of service, is that correct?
[CUSTOMER][NEUTRAL] Yeah, to do the data service I do have for this patient.
[AGENT][NEUTRAL] OK, and what is the first day of service and total bill amount, please?
[CUSTOMER][NEGATIVE] I mean, I, uh, the total bill amount is different. The date of service only one is, uh, [PII], and the first bill amount is $187 even and another one is $26 even.
[AGENT][NEUTRAL] So it's two separate claims for the same data service.
[CUSTOMER][NEUTRAL] Yes, 2 separate claim on the same sauce.
[AGENT][NEUTRAL] One moment please.
[AGENT][NEUTRAL] OK, so for the first.
[AGENT][NEUTRAL] Filled them out, the 187, we did receive that claim and just one moment.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Do you already have the claim numbers or you do not?
[CUSTOMER][NEUTRAL] I do not have the claim number and when when it was received.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] This claim was received 11-1-2024 processed 115-2024.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The claim number is 352-593-7.
[AGENT][NEUTRAL] The other claim for the $26 amount.
[AGENT][NEUTRAL] That claim was received on [PII] also processed on [PII].
[AGENT][NEUTRAL] And that claim number is 352.
[AGENT][NEUTRAL] 5945.
[AGENT][NEUTRAL] Both claims were denied for the same reason as.
[AGENT][NEUTRAL] And the denial remark for both state benefit max for this state of service has been met.
[CUSTOMER][NEUTRAL] Give me a moment, just wait a minute, OK.
[CUSTOMER][NEUTRAL] The claim has been denied because the maximum benefit has been met.
[AGENT][POSITIVE] That is correct. That is correct, yes ma'am.
[CUSTOMER][NEUTRAL] Right?
[CUSTOMER][NEUTRAL] OK, I just, uh, I just, uh, I just want to know the maximum benefit has been met in the terms of the dollar amount or the in terms of the services.
[AGENT][NEUTRAL] Dollar
[CUSTOMER][NEUTRAL] Uh, means the limit of the dollar amount.
[AGENT][NEUTRAL] $100.
[CUSTOMER][NEUTRAL] Uh, OK, $100 and the last the patient met on which date?
[AGENT][NEUTRAL] It was met on that same day service with a claim that was received prior to your claim being received.
[AGENT][NEUTRAL] There was another claim processed prior to yours being received.
[CUSTOMER][NEUTRAL] can, uh, you're able to provide me the claim number of that so we can check that it's been.
[AGENT][NEUTRAL] Uh, no, ma'am.
[AGENT][NEUTRAL] I can't provide another provider's claim information to you, only your provider.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] No problem. um, can we bill it to the patient by chance? the.
[AGENT][NEUTRAL] We do not determine patient responsibility, [PII] that would be up to the provider to make that determination.
[CUSTOMER][NEUTRAL] Uh, can you fax me the EOB if if it is possible, or?
[AGENT][NEUTRAL] That website that I get.
[CUSTOMER][NEUTRAL] I have to go through the
[CUSTOMER][NEUTRAL] Yeah, go ahead, the website, right, but uh if we do not have the login ID and password, so where we can get.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You would create your own, yes ma'am, you set it up yourself, you create the profile with the username and password.
[CUSTOMER][NEUTRAL] OK, no problem. Can you please help me have the reference number?
[AGENT][NEUTRAL] Sure, you would use my name.
[AGENT][NEUTRAL] That I gave you along with today's date.
[CUSTOMER][POSITIVE] OK, yeah, yeah, yeah, yeah, yeah, yeah, I know that. um, thank you, that's it for today. Thank you so much.
[AGENT][POSITIVE] Well, you're welcome [PII]. So if that is all I can help you with at the moment, and thank you again for calling APL, and I hope you have a very nice afternoon.
[CUSTOMER][NEUTRAL] You and I just want to know one more thing the claim process, uh, as an in network services or the out of network services.
[AGENT][NEUTRAL] Again, if for any network provider questions you would need to reach out to multi plan.
[CUSTOMER][POSITIVE] OK, so we are at the out of network. Thank you so much.
[AGENT][POSITIVE] OK, well you're very welcome. So again thank you for calling APL and I hope you have a very nice afternoon.
[CUSTOMER][POSITIVE] You too have a great day bye now.
[AGENT][POSITIVE] Yes, ma'am. Uh thank you, bye bye.